| NPI | 1619176203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A94591) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 048439) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 256173) | |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2011-10-25 |